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[»çÁø¼³¸í] GINA °¡À̵å¶óÀÎ
 
õ½Ä Ä¡·á °¡À̵å¶óÀÎÀÇ ÀÓ»ó È°¿ëµµ

ÀÔ·ÂÀÏ:2007-06-28 / Á¶È¸¼ö:6375 / Ãßõ¼ö:209 / ÀÛ¼ºÀÚ:ÇѸ¸¿ë
Àú¹øÁ¶ Çлýµé¿¡°Ô Çлý¶§ ¸¹ÀÌ ¹è¿ì°í Àִ õ½Ä Áߵ¿¡ ´ëÇÑ ÀÓ»ó Àû¿ë¿¡ °üÇÑ ³í¹®À» ³ª´©¾îÁÖ°í °°ÀÌ Åä·ÐÇÏ´Â ½Ã°£À» °®°Ô µÇ¾ú´Ù.

õ½ÄÀ» Ä¡·áÇϱâ À§Çؼ­´Â ¾ó¸¶³ª ¾ÆÀÌ Áõ»óÀÌ ½ÉÇÑ°¡¸¦ Á¤ÇÏ°í ÀÌ¿¡µû¶ó õ½Ä Ä¡·á ¹æ¹ýÀÌ °áÁ¤µÈ´Ù. ÀÌ·¯ÇÑ ´Ü°è Ä¡·á´Â ÇлýÀ̳ª Àü¹®ÀÇ ½ÃÇè¿¡ ¸¹ÀÌ ³ª¿À±â´Â Çϴµ¥ ½ÇÁ¦ ÀÓ»ó¿¡¼­ ¾î¶»°Ô È°¿ëµÇ´ÂÁö Àü°øÀdzª ÇлýµéÀº Àß ¸ð¸¥´Ù. À̹ø 3°³ÀÇ ³í¹®Àº ÀÌ·¯ÇÑ ´Ü°è Ä¡·á¸¦ °áÁ¤ÇÏ´Â ¿ä¼Ò '³·Áõ»ó' '¹ãÁõ»ó' 'Æó±â´É °Ë»ç ±â´ëÄ¡''Æó±â´É º¯µ¿À²' °£¿¡ ¼­·Î °ü·Ã¼ºÀÌ ¸¹Áö ¾Ê±â¿¡ õ½Ä Ä¡·á ´Ü°è¸¦ °áÁ¤Çϴµ¥ ¸Å¿ì È¥¶õ½º·´´Ù´Â ³»¿ëÀÌ Á¤¸®µÇ¾î ÀÖ´Ù.

ÀÌ ±ÛÀ» Àбâ Àü¿¡ õ½Ä ´Ü°è´Â µÎ°¡Áö Áß¿äÇÑ °¡À̵å¶óÀÎÀÌ ÀÖ´Ù´Â °ÍÀ» ¾Ë°í ÀÖ¾î¾ß ÇÑ´Ù. GINA °¡À̵å¶óÀÎÀº ij³ª´Ù, È£ÁÖ, À¯·´°è ÀÇ»çµé Áß½ÉÀ¸·Î ¸¸µç °ÍÀÌ°í NAEPP´Â ¹Ì±¹ ÀÇ»çµéÀÌ ¸¸µç °ÍÀÌ´Ù.

GINA(Global Initiative for Asthma) °¡À̵å¶óÀÎÀº 1993³â NIH»êÇÏ National Heart, Lung, and Blood Institute's(NHLBI's)¿Í WHO¿Í °øµ¿À¸·Î õ½Ä °¡À̵å¶óÀÎÀ» ¸¸µé¾ú°í ÀÌ°ÍÀÌ ¹ßÀüÇÏ¿© 2006³âÆDZîÁö ³ª¿ÍÀÖ´Ù.

NAEPP °¡À̵å¶óÀÎÀº ¹Ì±¹ National Heart, Lung, and Blood Institute's(NHLBI's)ÀÇ National Asthma Education and Prevention Program(NAEPP)ÀÇ Àü¹®°¡ ȸÀÇ(Expert Panel)¿¡¼­ ¸¸µç °¡À̵å¶óÀÎÀÌ´Ù. ÀÌ °¡À̵å¶óÀÎÀº 1989³â ù Àü¹®°¡ ȸÀǸ¦ ¿­¾î ÀÌ È¸ÀÇ °á°ú 1991³â NAEPP Expert Panel Report : Guidelines for the Diagnosis and Management of Asthma ¸¦ ÃâÆÇÇÏ¿´´Ù. ÀÌÈÄ 1995³â 2Â÷ Àü¹®°¡ ȸÀǸ¦ ÇÏ¿© 1997³â NAEPP Expert Panel Report 2 : Guidelines for the Diagnosis and Management of Asthma(EPR-2)¸¦ Ãâ°£ÇÏ¿´´Ù. (¿ø¹®º¸±â, Practical Guideline).

ÀÌÈÄ 2002³â »õ·Î¿î ³»¿ëÀÌ ¾÷µ¥ÀÌÆ®µÇ¾î NAEPP Expert Panel Report : Guidelines for the Diagnosis and management of Asthma Update on Selected Topics-2002 ¸¦ Ãâ°£ÇÏ¿´´Ù. ÀÌ ³»¿ëÀÌ The Jounal of Allergy and Clinical Immunology 2002³âÆÇ¿¡(Guidelines for the Diagnosis and Management of Asthma) ½Ç¸®¾ú´Ù.

¿ì¸®³ª¶ó °¡À̵å¶óÀεµ ¹°·Ð ÀÖ´Ù. ÆÄÀÏÀº ±¸ÇÏÁö ¸øÇÏ¿´Áö¸¸ GINA¸¦ ±âº»À¸·Î ÇÏ¿© ¸¸µç °ÍÀÌ´Ù. °¡Àå ¾Æ·¡¿¡ °¢±¹¿¡¼­ ¸¸µç õ½Ä °¡À̵å¶óÀÎ Á¾·ù¸¦ ³ª¿­ÇØ º¸¾Ò´Ù.

¼¼°³ÀÇ ³í¹® ¿ä¾àÀº ´ÙÀ½°ú °°´Ù.

ù¹ø° ³í¹® ; ±Ç¼ö°æ ÇлýÀÌ Á¤¸®ÇÏ¿´´Ù.

Classifying Asthma Severity in Children- mismatch between symptoms, medication use,and lung function ±Ç¼ö°æ
Ãâó ; Am J Respir Crit Care Med 2004;170(4):426.

õ½Ä Ä¡·á¿¡ ´ëÇÑ ÃÖ±ÙÀÇ °¡À̵å¶óÀÎÀº õ½ÄÀÇ ÁßÁõµµ¸¦ õ½ÄÁõ»óÀÇ ºóµµ, ¾à¹° Ä¡·á Á¤µµ, Æó±â´É °Ë»ç¸¦ ¹ÙÅÁÀ¸·Î ºÐ·ùÇÏ°í ÀÖ´Ù. ÀÌ ¿¬±¸ÀÇ ¸ñÀûÀº National Asthma Education and Prevention Program(NAEPP)/ Expert Panel Report 2 °¡À̵å¶óÀο¡ Á¤ÀǸ¦ ³»¸°´ë·Î Æó±â´É °Ë»ç°¡ õ½ÄÀÇ Áߵ¸¦ ¹Ý¿µÇÏ´ÂÁö È®ÀÎÇÏ´Â °ÍÀÌ´Ù. µÎ Àü¹®°¡ÀÇ ¿Ü·¡È¯ÀÚ Áß¿¡¼­ õ½ÄÀ» °¡Áø 5¼¼¿¡¼­ 18¼¼ »çÀÌÀÇ ¾ÆÀ̵éÀÇ ºÎ¸ðµé¿¡°Ô Áö³­ 1ÁÖ°£ ¹ÞÀº õ½Ä ¾à¹° Ä¡·á¿Í Áö³­ 4ÁÖ °£ÀÇ Áõ»ó ºóµµ¿¡ °üÇÏ¿© ¼³¹®Áö¸¦ ÅëÇÏ¿© Á¶»çÇÏ¿´´Ù. ¸ðµç ¾ÆÀ̵éÀº Æó±â´É °Ë»ç¸¦ ¼öÇàÇÏ¿´´Ù. õ½ÄÀÇ Áߵ¸¦ õ½Ä Áõ»ó ºóµµ ¶Ç´Â ¾à¹° »ç¿ë Áß ´õ ½ÉÇÑ Á¤µµ·Î ¼±ÅÃÇßÀ» ¶§ °æÁõ °£Ç漺(mild intermittent)ȯÀÚ´Â Âü°¡ÀÚÀÇ 6.9%¿´°í °æÁõ Áö¼Ó¼º (mild persistent)ȯÀÚ°¡ 27.9%, ÁßµîÁõ Áö¼Ó¼º(moderate persistent)ȯÀÚ°¡ 22.4%, (ÁßÁõ Áö¼Ó¼º(severe persistent)ȯÀÚ°¡ 42.9%¿´´Ù. FEV%predictedÀÇ °ªÀº õ½Ä Áߵ´Ü°è¸¶´Ù Â÷ÀÌ°¡ ¾ø¾ú´Ù. FEV1/FVC´Â õ½Ä Áߵ°¡ Áõ°¡ÇÒ ¶§ °¨¼ÒÇÏ¿´À¸³ª (p<0.0001) Âü°¡ÀÚÀÇ 33%¿¡¼­¸¸ ºñÁ¤»óÀûÀÎ °ªÀ» º¸¿´°í õ½ÄÀÇ Áߵ°¡ ½ÉÇØÁú¼ö·Ï ºñÁ¤»óÀûÀÎ FEV1/FVC°ªÀ» °®´Â Âü°¡ÀÚÀÇ ¼öµµ Áõ°¡ÇÏ¿´´Ù(p=0.0001). ¾ÆÀ̵鿡°Ô À־ õ½ÄÀÇ Áߵ¸¦ Áõ»óÀÇ ºóµµÀÇ ¾à¹° Ä¡·á·Î Æò°¡ÇÏ´Â ¹æ¹ýÀº NAEPP °¡À̵å¶óÀο¡¼­ ±ÔÁ¤ÇÑ FEV1Ç׸ñ°ú ¿¬°ü¼ºÀÌ ¾ø¾ú´Ù. FEV1Àº ´ë°³ Á¤»óÀ̾ú°í ÁßÁõ Áö¼Ó¼ºÀÎ ¼Ò¾Æ õ½ÄȯÀÚµµ Á¤»óÀ̾ú´Ù. ¹Ý¸é FEV1/FVC´Â õ½ÄÀÇ Áߵ°¡ Áõ°¡Çϸ鼭 °¨¼ÒÇÏ¿´´Ù.

µÎ¹ø° ³í¹® ; ÀÌÁÖÅà ÇлýÀÌ Á¤¸®ÇÏ¿´´Ù.

Classifying asthma : disagreement among specialists.
Ãâó ; Chest 2003;124(6):2156

Introduction

1. ÀÌ»óÀûÀΠõ½Ä ÁßÁõµµ ºÐ·ùÀÇ °¡À̵å¶óÀÎÀº ȯÀÚÀÇ »óŸ¦ ¿¹ÃøÇÒ ¼ö ÀÖÀ¸¸ç Ä¡·á¿¡ ½ÇÁúÀûÀ¸·Î ÀûÀÀÇÒ ¼ö ÀÖ´Â °ÍÀ̾î¾ß ÇÑ´Ù.

2. °¡Àå ³Î¸® ÀÌ¿ëµÇ°í ÀÖ´Â NAEPP °¡À̵å¶óÀΰú GINA °¡À̵å¶óÀÎÀº õ½Ä ȯÀÚÀÇ Ä¡·á¿¡ À־ ´Ü°èÀû Á¢±ÙÀ» »ç¿ëÇÏ°í Àִµ¥, ÀÌ·¯ÇÑ ´Ü°èÀû Á¢±ÙÀ» À§Çؼ­´Â ȯÀÚÀÇ ÁßÁõµµ°¡ ¾î´À ¼öÁØ¿¡ ¿Í ÀÖ´ÂÁö¿¡ ´ëÇÑ Á¤È®ÇÑ Æò°¡°¡ ÇÊ¿äÇÏ´Ù.

3. õ½ÄÀ» Ä¡·áÇÏ´Â Àü¹®°¡µé »çÀÌÀÇ ÁßÁõµµ Æò°¡¿¡ À־ÀÇ ÀÇ°ß ºÒÀÏÄ¡´Â õ½ÄÀÇ Ä¡·á°¡ È¿°úÀûÀ¸·Î ÀÌ·ç¾î ÁöÁö ¾Ê°Ô ÇÒ °¡´É¼ºÀÌ ÀÖÀ¸¹Ç·Î, Á¤È®ÇÑ Æò°¡´Â Áß¿äÇÏ´Ù.

õ½ÄÀÇ ºÐ·ù¿Í Áø´Ü.

1. ÀÇ»çµé »çÀÌ¿¡¼­µµ õ½Ä ȯÀÚÀÇ ÁßÁõµµ ºÐ·ù¿¡ À־ ÀÇ°ßÀÇ ºÒÀÏÄ¡¸¦ º¸ÀÌ°í ÀÖ´Ù.

2. ÀÌ·¯ÇÑ ¹®Á¦´Â õ½ÄÄ¡·áÀÇ °¡À̵å¶óÀο¡ ´ëÇÑ ¿¬±¸¿Í º´¸®±âÀüÀÌ ¸íÈ®È÷ ¹àÇôÁø´Ù¸é ÇØ°áµÉ ¼ö ÀÖ´Â ¹®Á¦¶ó°í ¿©°ÜÁø´Ù.

õ½ÄÀÇ ºÐ·ù¸¦ À§ÇÑ ÀÌÇØ

1. NAEPP °¡À̵å¶óÀÎÀº õ½ÄȯÀÚÀÇ ÁßÁõµµ ºÐ·ù¿¡ À־, ³· ±â°£µ¿¾ÈÀÇ Áõ»ó, ¹ã¿¡ ³ªÅ¸³ª´Â Áõ»ó ±×¸®°í Æó±â´É °Ë»ç¸¦ °ÅÀÇ °°Àº Áß¿äµµ¸¦ °¡Áø´Ù.

2. ÇÏÁö¸¸ Æó±â´É °Ë»çÀÇ ´ëÇ¥°ªÀÎ FEV1°ª°ú PEF´Â ¸¹Àº ¼öÀÇ È¯ÀÚ¿¡¼­ ¼­·Î ÁßÁõµµ ºÐ·ù°¡ ÀÏÄ¡µÇÁö ¾Ê´Â °æ¿ì°¡ ¸¹´Ù.

3. ¶ÇÇÑ È£Èí±â´ÉÀÌ ÀúÇÏµÈ ÁßÁõÀÇ Ãµ½ÄȯÀÚ¿¡¼­µµ Æó±â´É °Ë»ç»ó Á¤»ó ¼Ò°ßÀÌ ³ª¿Ã ¼öµµ ÀÖ´Ù.

4. ÀÌ·¯ÇÑ Áõ»ó°ú ±â´É°Ë»ç»óÀÇ À¯ÀÇÇÒ ¸¸ÇÑ ºÒÀÏÄ¡´Â ȯÀÚÀÇ ÁßÁõµµ ºÐ·ù¸¦ ¾î·Æ°ÔÇÏ°í ÀÌ·ÎÀÎÇØ À߸øµÈ ¾à¹°Ä¡·á°¡ ÇàÇØÁú °¡´É¼ºÀ» ³»Æ÷ÇÏ°í ÀÖ´Ù.

5. ¶ÇÇÑ À§ÀÇ µÎ °¡À̵å¶óÀÎÀº õ½ÄÀÇ ÁßÁõµµ ºÐ·ù¿¡¼­ ¡°°¡Àå ½ÉÇÑ Áõ»ó ±âÁØ¡±À» »ç¿ëÇÏ°í ÀÖ´Ù. Áï ³· Áõ»óº¸´Ù ¹ã Áõ»óÀÌ ½ÉÇÒ °æ¿ì ¹ã Áõ»óÀ» ±âÁØÀ¸·Î õ½ÄÀÇ ÁßÁõµµ¸¦ Æò°¡ÇÑ´Ù´Â °ÍÀÌ´Ù.

6. ÀÌ·¯ÇÑ ÁßÁõµµ Æò°¡´Â ¸¹Àº °æ¿ì¿¡¼­ ȯÀÚÀÇ Áõ»óÀÌ °ú´ëÆò°¡µÉ °¡´É¼ºÀ» ³»Æ÷ÇÏ°í ÀÖ´Ù.

½ÇÁ¦ ÀÓ»ó¿¡¼­ÀÇ ¹®Á¦Á¡

1. ¶ÇÇÑ ÀÓ»óÀÇ»çµéÀº ȯÀÚÀÇ °Ë»ç°á°ú³ª ¾à¹° »ç¿ëÁ¤µµ¸¦ Æò°¡ÇÔ¿¡ À־, ȯÀÚÀÇ ÁßÁõµµ¸¦ °ú¼ÒÆò°¡ÇÏ´Â °æ¿ì°¡ ÀÖ´Ù.

2. ÀÌ·¯ÇÑ °æ¿ì ȯÀÚ¿¡°Ô ÀûÀýÇÑ ¾à¹°Ä¡·á°¡ ÀÌ·ç¾îÁöÁö ¾Ê¾Æ ȯÀÚÀÇ Áõ»ó°³¼±ÀÌ Èûµé ¼ö ÀÖ´Ù.

3. ȯÀÚÀÇ ÁßÁõµµ Æò°¡°¡ Á¤È®ÇÏ·Á¸é ȯÀÚ°¡ ¾àÀ» º¹¿ëÇÏÁö ¾ÊÀº »óÅÂÀ̾î¾ß Á¤È®ÇÑ Áõ»óÀÇ Á¤µµ Æò°¡°¡ °¡´É ÇÏÁö¸¸ ½ÇÁ¦ ÀÓ»ó¿¡¼­´Â ºÒ°¡´ÉÇϸç, ÇöÀçÀÇ °¡À̵å¶óÀÎÀº Çѹø ȯÀÚÀÇ ÁßÁõµµ°¡ °áÁ¤µÇ¸é ȯÀÚÀÇ »óź¯È­³ª °èÀý¿¡ µû¸¥ Áõ»óº¯È­¸¦ ¹Ý¿µÇϱⰡ Èûµé°Ô µÇ¾îÀÖ´Ù.

ÁßÁõµµ Æò°¡¸¦ À§ÇÑ ´ë¾Èµé.

1. °´´ãÀ¯¹ß°Ë»ç¸¦ ÀÌ¿ëÇÏ¿© °´´ã³»ÀÇ È£»ê±¸ ¼öÄ¡¸¦ »ç¿ëÇϰųª È£±â½Ã ³ª¿À´Â ÀÌ»êÈ­ Áú¼ÒÀÇ ³óµµ¸¦ ÀÌ¿ëÇÏ¿© È£Èí±â³»ÀÇ ¿°Áõ Á¤µµ¿¡ ´ëÇÑ Æò°¡°¡ °¡´ÉÇÒ °ÍÀÌ´Ù.

2. ¶ÇÇÑ Á¤ÇØÁø ÇÁ·ÎÅäÄÝ¿¡ÀÇÇÑ ¼³¹® ¹× ¼öÄ¡È­¸¦ ÅëÇÑ È¯ÀÚÀÇ Áõ»ó Áß½ÉÀÇ ÁßÁõµµ Æò°¡´Â ¸ÂÃãÄ¡·á¶ó´Â Ãø¸é¿¡¼­ ´õ ¹Ù¶÷Á÷ ÇÒ ¼ö ÀÖÀ» °ÍÀÌ´Ù.

°á·Ð

1. õ½ÄȯÀÚÀÇ ÁßÁõµµ Æò°¡¿¡ À־ ÇöÀçÀÇ °¡À̵å¶óÀÎÀº ÁßÁõµµÀÇ Ã¼°èÈ­¶ó´Â Ãø¸é¼­¼­´Â °ý¸ñÇÒ ¸¸ÇÑ ¼º°ú¸¦ ÀÌ·ç¾úÁö¸¸, ½ÇÁ¦ ÀÓ»ó¿¡¼­ÀÇ Àû¿ëÀº ¸¹Àº ºñÆÇÀ» ¾ß±âÇÏ°í ÀÖ´Ù.

2. µû¶ó¼­ ¾ÕÀ¸·Î ´ÙÁßÀû Ãø¸éÀ» °¡Áø õ½ÄÀ̶ó´Â Áúº´¿¡ ´ëÇÑ ´Ù¾çÇÑ Á¢±Ù ¹× ȯÀÚÀÇ »óÅ º¯È­ ±îÁöµµ ¹Ý¿µÇÒ ¼ö ÀÖ´Â »õ °¡À̵å¶óÀο¡ ´ëÇÑ ¿¬±¸°¡ ÇÊ¿äÇÒ °Í ÀÌ´Ù.

¼¼¹ø° ³í¹®Àº ÀÌÅÂ±Ô ÇлýÀÌ Á¤¸®ÇÏ¿´´Ù.

Relationship between Increased Airway Responsiveness and Asthma Severity in the Childhood Asthma Management Program
Ãâó ;Am J Respir Crit Care Med 2000;162(1):50

¼Ò¾Æ õ½Ä¿¡¼­ ±âµµ °ú¹Î¼ºÀÇ Á¤µµ¿Í õ½ÄÀÇ ÁßÁõµµÀÇ °ü°è´Â ºÒºÐ¸íÇÏ´Ù. Child-hood Athma Management Program(CAMP)¿¡ Âü°¡ÇÑ °æÁõ¿¡¼­ ÁߵÀÇ Ãµ½ÄÀ» °¡Áø 1041¸íÀÇ ¾î¸°À̸¦ ´ë»óÀ¸·Î PC20ÀÇ °ª°ú Æó±â´É, È£Èí±â Áõ»óÀÇ ºóµµ, º´ÀÇ Áö¼Ó±â°£, ±×¸®°í Àü¹®°¡¿¡ ÀÇÇØ Æò°¡µÈ º´ÀÇ ÁßÁõµµ¿ÍÀÇ °ü°è¿¡ ´ëÇÏ¿© ¿¬±¸ÇÏ¿´´Ù. ¿¬±¸ °á°ú PC20ÀÇ °ªÀÌ ³·À»¼ö·Ï Æó±â´ÉÀÌ ÀúÇϵǰí, Áõ»óÀÇ ºóµµ°¡ ´Ã¾î³ª¸ç, Àü¹®°¡¿¡ ÀÇÇØ Æò°¡µÈ ÁßÁõµµ°¡ Ä¿Áö¸ç, º´ÀÇ Áö¼Ó±â°£ÀÇ ´Ã¾î³ª´Â °ÍÀ¸·Î ¹àÇôÁ³´Ù. ÀÌ·¯ÇÑ °á°ú´Â ¼Ò¾Æ õ½Ä¿¡¼­ ±âµµ°ú¹Î¼ºÀÇ Á¤µµ¿Í õ½ÄÀÇ ÁßÁõµµ´Â °ü°è°¡ ÀÖ´Ù´Â °ÍÀ» º¸¿©ÁØ´Ù.

ÄÚ¸àÆ®

´ÙÀ½Àº °¢ ÇлýÀÇ ³í¹®¿¡ ´ëÇÑ ÄÚ¸àÆ®Àε¥ ¸î ÇлýÀº ³»¿ëÀ» Á¤¸®¸¸ Çؼ­ ½ÆÁö ¾Ê¾Ò´Ù.

ÀÌÁÖÅÃ

À̹ø¿¡ ¸ÃÀº Àú³Î ¹ßÇ¥ÀÇ ÁÖÁ¦´Â ¡°Ãµ½ÄÀÇ ÁßÁõµµ ºÐ·ù¡±¿¡ ´ëÇÑ ¸®ºä¸¦ ´ãÀº ³»¿ëÀ̾ú´Ù. ¿ì¸®°¡ ±³°ú¼­ »ó¿¡¼­ ±×³É ´Þ´Þ ¿Ü¿ì±â¸¸Çß°í, ±Ý°ú¿ÁÁ¶·Î¸¸ ¿©±â´ø °¡À̵å¶óÀÎÀÌ ½ÇÁ¦ ÀÓ»óÇöÀå°ú ¸¹ÀÌ µ¿¶³¾îÁ® ÀÖ´Ù´Â °Í¿¡ ³î¶ú°í, ¿ì¸®³ª¶óµµ ¿ì¸® ¾ÆÀ̵éÀÇ ¼ºÀå°ú ÀÓ»ó°æ°ú¿¡ ¸Â´Â µ¶ÀÚÀûÀΠõ½ÄÀÇ °¡À̵å¶óÀÎÀÌ Á¦Á¤µÉ ÇÊ¿ä°¡ ÀÖÀ» °ÍÀ¸·Î »ý°¢ÇÑ´Ù.

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